Medication errors and patient complications with continuous renal replacement therapy.

Pediatric Nephrology : Journal of the International Pediatric Nephrology Association
Jeffrey F BarlettaT Bunchman

Abstract

Continuous renal replacement therapy (CRRT) is commonly used for renal support in the intensive care unit. While the risk of medication errors in the intensive care unit has been described, errors related specifically to CRRT are unknown. The purpose of this study is to characterize medication errors related to CRRT and compare medication errors that occur with manually compounded solutions versus commercially available solutions. We surveyed three separate internet-based, pediatric list serves that are commonly used for communications for programs utilizing CRRT. Data regarding CRRT practices and medication errors were recorded. Medication errors were graded for degree of severity and compared between programs using manually compounded dialysis solutions versus commercially available dialysis solutions. In a survey with 31 program responses, 18 reported medication errors. Two of the 18 were related to heparin compounding, while 16/18 were due to solution compounding errors. Half of the medication errors were classified as causing harm, two of which were fatal. All medication errors were reported by programs that manually compounded their dialysis solutions. Medication errors related to CRRT are associated with a high degree of...Continue Reading

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Citations

Feb 3, 2009·Intensive Care Medicine·Graeme Maclaren, Warwick Butt
May 17, 2008·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Scott WaltersPatrick D Brophy
Nov 21, 2009·Critical Care : the Official Journal of the Critical Care Forum·Maria J SantiagoJose María Bellón
Mar 20, 2010·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Brad MoriyamaGeorge J Grimes
Sep 16, 2008·Seminars in Nephrology·Timothy E BunchmanStuart L Goldstein
May 27, 2008·Pediatric Clinics of North America·Joseph A Carcillo
Jan 18, 2012·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Hoi-Ping ShumWing-Wa Yan
Apr 27, 2016·Advances in Chronic Kidney Disease·Lenar YessayanBalazs Szamosfalvi
Aug 18, 2017·Critical Care Medicine·Sandra L Kane-GillBrian S Smith
Feb 7, 2018·Seminars in Dialysis·Michael Heung, Bruce A Mueller
May 29, 2018·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Alexander R ShawBruce A Mueller
Sep 2, 2016·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Timothy E Bunchman
Mar 4, 2017·AACN Advanced Critical Care·Hildy Schell-Chaple
Mar 4, 2008·The International Journal of Artificial Organs·N GibneyC Ronco
Mar 4, 2008·The International Journal of Artificial Organs·J A KellumP M Palevsky

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